With increases in caseload size it can be difficult to organize and structure groups in order to ensure that our students get the most out of their therapy time. Join us as we discuss a pilot study that examines how to group multiple children with multiple disorders in short, intense therapy and produce great results.

2. Disclosure Statement:
Financial —
Kara Anderson works with Bilinguistics.
Bilinguistics receives royalties from product
sales.
Nonfinancial — None

3. The Origins of Our Pilot Study
• We have large, diverse caseloads that grow
throughout the school year.
Questions:
• Is there a more efficient way to serve our
students and not sacrifice quality?
• What are other academic areas doing to improve
services?
• Can academic models work within the
framework of speech pathology?

4. Our Discussion Today
• Identify successful intervention techniques and
service delivery models.
• Discuss research on improving clinical services
• Review results of a clinic camp that tests these
ideas for speech-language intervention
• Apply these successes to the school setting
• Provide therapy plans for implementing changes
to how you provide intensity of services

5. Professional Constraints
• Location of Service
• Format of Service (group vs. Individual)
• Dosage (Frequency, Intensity of Services)
• Insurance
• Federal Mandates
▫ IDEA
▫ Least Restrictive Environment

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8. What aspects of our profession
influence intervention practices?

9. Improved Language Outcomes
• Gillam and Loeb, (2010) reported that four
components of language intervention were
associated with successful language outcomes
▫ Intensity
▫ Active Attention
▫ Feedback
▫ Rewards

10. Increased Vocabulary
• Repetition of Vocabulary words requires
exposure of at least 15 times (Pui Fong, 2010 )
• Longer interventions
• Teaching words through definitions and in
context (Stahl & Fairbanks, 1986)
• More word encounters
• Active processing (Baumann et.al, 2003 and A. Graves, 1986)

11. Evidence-based Intervention
Techniques
• Literacy-based intervention
• Imitation
• Modeling
• Cloze procedures
• Binary choice
• Expansion
• Recast
• Scaffolding

12. Why do we provide services for the
amount of time that we currently do?

13. Mixed Results
• Studies on the following topics found mixed
results
• Dosage (frequency)
• Parent implemented vs. clinician administered
• Classroom-based vs. Pull-out
• School vs. Clinic
▫ (Schooling et. al., 2010)

14. Click for Audio‐over‐Powerpoint Presentation

15. ▫ 30/60 minutes twice a week
▫ direct service on average 2-4 kids per group
▫ Who ever decided on 30 minutes/week ?
?

16. Alternative Delivery Models
▫ Limited research on group intervention
 Adults with aphasia
 Hearing impairments
 Stuttering
 Very little addresses speech & language
 Early-childhood intervention

17. Alternative Delivery Models
• Recent Studies found intensity as a consistent
factor that contributed to increased language
outcomes
▫ Gillam et.al (2008) , Loeb et. al. (2009),
Tomblin, (2007), Gillam and Loeb (2010)

18. Define “Intensity”
• “The number of hours of intervention over a
specific time period.” (Lovaas)
• “The ratio of adult to children” (Graff et. al.)
• “The quality and quantity of services in a given
period of time.”(Barnett & Escobar)
• “The number of specific teaching episodes per
unit of time.” (Guralnick)
From Ukrainetz et. al. 2008

19. How Much is Necessary?
• How often should we use therapeutic techniques
in a session?
• Which techniques work best for working on
specific goals?
▫ (Ukrainitz, et.al. 2008)

20. Research on intensity-over-time is
contradictory
• Intervention of more than 8 weeks was more
effective than less than 8 weeks (From Ukrainitz et.al, 2008; Law
et. al, 2004)
Contradicted by:
• Intensive 6 week service delivery model showed
5x the gains as a traditional 2-year service
delivery model ( Gillam & Loeb, 2010)
▫ Number of delivery hours being equal

21. Study on Intensity
• Could we do a study of intensity that applies to a
public school population?
• How does the Bilinguistics pilot study look
different from the Gillam et.al. (2010) than the
study?
• How would we create a larger scale study in the
public school setting?

22. Could we alter the
frequency and intensity
of speech therapy and get
equal or greater results?

23. Applying a Pilot Study of
Intensity to our Field.
• Individual
• Monolingual English
• 1:40/day for 6 weeks
• Literacy-based, computer
program and academic
program
• Only enrolled children with
language impairments
• Group
• Bilingual population
• 2:00/day for 2 weeks
• Literacy-based program
• Children with speech,
language, hearing, social and
cognitive disorders enrolled in
program
Gillam Study Bilinguistics Study

24. Study Overview
• The current study examined the efficacy of a
short-term intensive group intervention
program for both English and Spanish-speaking
children ages 3-8 with all classes of disorders.

25. Methods
 Participants-6 children per group
 2 groups of 3-5 year old bilinguals
 2 groups of 3-5 year old English speakers
 1 group of 6-8 year old bilinguals
 1 group 6-8 year old English speakers
 Time
 Two week sessions, 4 days per week
 Intensity
 2 hours per day
 Disorders
 All disorders (Autism, speech and language impairment,
Down Syndrome)

26. Time Schedule Activity Goals
8:50-9:00 Arrival
9:00-9:15 Circle Time
Greeting/ Attendance
Clinician A
9:15-9:20 Jobs
Clinician A
9:20-9:30 Calendar
Clinician A
9:30-9:35 Music
Clinician A
9:35-9:40 Language goal
Clinician A

27. Time Schedule Activity Goals
8:50-
9:00
Arrival
9:00-
9:15
Circle Time
Greeting/
Attendance
Clinician A
Name recognition: Clinician
hold up name card and kids
find the student.
Clinician: Who’s name is on
the card?
Students: Jacob!
Clinician: Where is Jacob?
Students: Over there
Clinician: That’s right, he is
next to Keith
Ok, Keith, where do I put you
name, Under the boy or
under the girl?
1. Phoneme
identification
2. Who question
3. Where questions
4. Joint attention
5. Spatial concepts
9:15-
9:20
Jobs
Clinician A
Six jobs: Capitan Energy
(lights), Super sponge (clean-
up), Fantastic furniture (
1. Who questions
2. Responsibility
3. Object-action

28. Time Schedule Activity Goals
9:15-
9:20
Jobs
Clinician A
Six jobs: Capitan Energy
(lights), Super sponge (clean-
up), Fantastic furniture
(tables and chairs are put up),
Time machine man (calendar
helper), Line leader, Snack
helper. Give out badges for
each job.
1. Who questions
2. Responsibility
3. Object-action
9:20-
9:30
Calendar
Clinician A
1. Go over months in a year
and then dance the
Macarena to the songs
(January, February, etc.).
2. Review Days of the weeks,
snap the Days of the week
song.
1. sequences
2. numbers
3. categories
4. verb tense
9:30-
9:35
Music
Clinician A
Children choose two songs to
dance to
1. Increase sentence
length
2. Which questions
3. sequence

29. Time Schedule Activity Goals
9:00-
9:15
Circle Time
Greeting/
Attendance
Clinician A
Name recognition: Clinician
hold up name card and kids
find the student.
1. Phoneme
identification
2. Who question
9:15-
9:20
Jobs
Clinician A
Six jobs: Capitan Energy
(lights), Super sponge (
1. Who questions
2. Responsibility
3. Object-action
9:20-
9:30
Calendar
Clinician A
1. Go over months in a year
and then dance the
Macarena to the songs
(January, February,
etc.).
2. Review Days of the
weeks, snap the Days of
the week song.
3. Review the date. Today
is X. Yesterday was X.
Tomorrow will be X.
1. sequences
2. numbers
3. categories
4. verb tense

30. Time Schedule Activity Goals
9:20-
9:30
Calendar
Clinician A
1. Go over months in a year
and then dance the
Macarena to the songs
(January, February, etc.).
1. sequences
2. numbers
3. categories
4. verb tense
9:30-
9:35
Music
Clinician A
Children choose two songs to
dance to
Clinician: Which songs do you
want to hear? Pick two songs.
Student: I want the animal
song and the Hokey Pokey
song.
Provide visual choices. After
student picks the songs, place
the pictures on a board that
say First, then.
1. Increase
sentence length
2. Which
questions
3. sequence
9:35-
9:40
Language
goal
Clinician A
Clinician: Today we are going
to learn about our body parts
and why we need them. We
use our nose to smell, eyes to
see, etc.
1. Object-action
2. Category
generation

31. Time Schedule Activity Goals
9:30-
9:35
Music
Clinician A
Children choose two songs to
dance to
Clinician: Which songs do you
want to hear? Pick two songs.
Student: I want the animal
song and the Hokey Pokey
song.
1. Increase
sentence length
2. Which
questions
3. sequence
9:35-
9:40
Language
goal
Clinician A
Clinician: Today we are going
to learn about our body parts
and why we need them. We
use our nose to smell, eyes to
see, etc.
Draw a word map and ask the
kids to label their body parts.
Clinician: What do we do with
our eyes?
1. Object-action
2. Category
generation
9:40-
9:45
Phonological
goal
Clinician A
Clinician: We are also going to
learn about the letter /s/. It
makes a sound like a snake.
1. final /s/

32. Time Schedule Activity Goals
9:35-
9:40
Language
goal
Clinician A
Clinician: Today we are going
to learn about our body parts
and why we need them. We
use our nose to smell, eyes to
see, etc.
Draw a word map and ask the
kids to label their body parts.
Clinician: What do we do with
our eyes?
1. Object-action
2. Category
generation
9:40-
9:45
Phonological
goal
Clinician A
Clinician: We are also going to
learn about the letter /s/. It
makes a sound like a snake.
1. final /s/
9:45-
9:55
Literacy
Center
Clinician B
Read the book: From Head to
Toe, By Eric Carle.
Use scaffolding techniques
while reading the book with
the students.
Focus on language target.
1. Object actions
2. Final /s/

33. Time Schedule Activity Goals
9:40-9:45 Phonological
goal
Clinician A
Clinician: We are also going to
learn about the letter /s/. It
makes a sound like a snake.
1. final /s/
9:45-9:55 Literacy
Center
Clinician B
Read the book: From Head to
Toe, By Eric Carle.
Use scaffolding techniques
while reading the book with
the students.
Focus on language target.
1. Object actions
2. Final /s/
9:55-10:25 Stations:
Each
children
rotates 10
minutes at
each station
Station 1
(Undergrad)
:Auditory
bombardment/Pho
nological awareness
with student
clinician
Station 2:
(Clinician
B) language
station with
SLP
Station 3
(Clinician A):
speech station
with SLP

34. Time Schedule Activity Goals
9:55-
10:25
Stations:
Each children
rotates 10
minutes at
each station
Station 1:
(Undergrad) Auditory
bombardment
/Phonological
awareness with
student clinician
Station 2:
(Clinician B)
language station
with SLP
Station 3
(Clinician A):
speech station
with SLP
1. Words with final
/s/. Students will
have materials to
color while
listening to the
words.
2. The phonological
awareness activity
is a matching
game with words
that rhyme (eyes,
ties; nose, toes;
hand, sand)
Ball game: Do
you want to
throw the ball
with your hands
or kick the ball
with your feet?
Trace the
student’s body
on butcher
paper. Draw the
parts of the body
and practice the
final /s/.

35. Time Schedule Activity Goals
9:55-
10:25
Stations:
Each
children
rotates 10
minutes at
each station
Station 1
(Undergrad)
:Auditory
bombardment/P
honological
awareness with
student clinician
Station 2:
(Clinician B)
language
station with
SLP
Station 3
(Clinician A):
speech station
with SLP
10:25-
10:40
Snack time
Clinician A
Cheese sandwiches.
Students make sandwich.
Place two raisins for eyes,
one for a nose. Lettuce for
hair, tomato for lips.
1. sequence
2. body parts
3. object-action
10:40-
10:50
Literacy
Center
Clinician B
Group activity- Read the
book again and act out the
actions. Stomp with my
feet, etc.
1. object-action
2. final /s/

36. Time Schedule Activity Goals
10:25-
10:40
Snack time
Clinician A
Cheese sandwiches.
Students make sandwich.
Place two raisins for eyes,
one for a nose. Lettuce for
hair, tomato for lips.
1. sequence
2. body parts
3. object-action
10:40-
10:50
Literacy
Center
Clinician B
Group activity- Read the
book again and act out the
actions. Stomp with my
feet, etc.
1. object-action
2. final /s/
10:50-
11:00
End of the
day
Clinician A
Review the language target
and phonological target.
Today we learned what our
body parts can do. We also
learned that some of the
words end in /s/ because
there are two of them.
Play end of the day music.

37. Time Schedule Activity Goals
10:40-
10:50
Literacy
Center
Clinician B
Group activity- Read the
book again and act out the
actions. Stomp with my feet,
etc.
1. object-action
2. final /s/
10:50-
11:00
End of the
day
Clinician A
Review the language target
and phonological target.
Today we learned what our
body parts can do. We also
learned that some of the
words end in /s/ because
there are two of them.
Play end of the day music.
Students gather their back
packs and form a line at the
door

38. Time Schedule Activity Goals
10:40-
10:50
Literacy
Center
Clinician B
Group activity- Read the
book again and act out the
actions. Stomp with my feet,
etc.
1. object-action
2. final /s/
10:50-
11:00
End of the
day
Clinician A
Review the language target
and phonological target.
Today we learned what our
body parts can do. We also
learned that some of the
words end in /s/ because
there are two of them.
Play end of the day music.
Students gather their back
packs and form a line at the
door

39. Therapy Planning-Caseload 50 across
2 schools
• Intensity
▫ Students will receive 8 hours of therapy every six
weeks
• Forming groups
▫ Groups classified by disorder or age?
• Alternating schedule
▫ 3 groups of 16 students (1,2,3)
▫ Each group will have an rotating schedule (a, b, c,
d,e)
▫ Group are rotated through two week cycles along
with alternating daily schedule

40. Therapy Planning-Caseload 50 across
2 schools
Monday Tuesday Wednesday Thursday ARD day
8:00‐9:00 Group a Group e Group d Group c
9:05‐10:05 Group b Group a Group e Group d
10:10‐11:10 Group c Group b Group q Group e
11:10‐11:40 lunch lunch lunch lunch
11:40‐1240 Group d Group c Group b Group a
12:40‐1:40 Group e Group d Group c Group b
1:45‐2:45 Flexible
hour
1 Rotation of a two week session

41. Schematic of a Therapy Session
▫ Introduction – greeting
▫ Pre-Reading
▫ Reading
▫ Post reading
▫ Direct Therapy
▫ Closing

42. Choosing Books and Music
• Songs and the Books Remained the Same
• Repetition builds vocabulary and knowledge
• Books varied by:
▫ Complexity
▫ Length
▫ Interest
▫ Child’s progress

43. Group Size and Behavior
• One adult per station
▫ 6-9 children in total group
▫ Auditory Bombardment
• Positive Behavior Management
▫ Rewarded students in front of everyone
▫ Extremely consistent
• Post Process Review
▫ Discussed what we did well
▫ Discussed how to improve the next session

44. Younger Group-Spanish

45. Younger Group-Spanish
Review

46. How can I adapt therapy to take
advantage of changes in intensity?

47. Results
• Complete data sets on 13 students
• (4 Spn, 9 Eng)
• Standardized testing
• Narrative language sample
▫ Phonological errors
▫ Word/utterance errors
▫ Type-token ratio
▫ MLU
▫ Story grammar components

48. MLU in Words
0
1
2
3
4
5
6
7
IS CL RG BE IG JF NC AC IR
English Mean Length of
Utterance
Pre‐MLUW
0
1
2
3
4
5
6
AG AA JR KV
Spanish Mean Length of
Utterance
Pre‐MLUW
Post‐MLUW

49. Total Number of Words
0
50
100
150
200
250
300
350
400
IS CL RG BE IG JF NC AC IR
English Total Number of Words
Pre TNW
Post TNW
0
50
100
150
200
250
300
350
400
450
AG AA JR KV
Spanish Total Number of Words
Pre TNW
Post TNW

50. Number of Different Words
0
20
40
60
80
100
AG AA JR KV
Spanish Number of Different
Words
Pre NDW
Post NDW
0
20
40
60
80
100
120
140
IS CL RG BE IG JF NC AC IR
English Number of Different
Words
Pre NDW
Post NDW

51. Number of Word Errors
0
5
10
15
20
25
30
35
40
45
50
IS CL RG BE IG JF NC AC IR
English Word Errors
PreWord Errors
PostWord Errors
0
5
10
15
20
25
30
AG AA JR KV
Spanish Word Errors
PreWord Errors
PostWord Errors

52. Implications - Summary
• Short-term intensive intervention is beneficial
for speech and language development
• Children can benefit from intensive group
intervention
• This could have implication for service delivery
in the schools

53. • Dickson, K., Marshall, M., Boyle, J., McCartney, E., O’Hare, A., Forbes, J. (2009). Cost
analysis of direct versus indirect and individual versus group modes of manual-based
speech and language therapy for primary school-age children with primary language
impairment. International Journal of Language & Communication Disorders, 44, 3, 369-
381.
• Edgar, D. L., Rosa-Lugo, L. I. (2007). The critical shortage of speech-language pathologists
in the public school setting: Features of the work environment that affect recruitment and
retention. Language, Speech, and Hearing Services in Schools, 38, 31-46.
• Gillam, R. B., Love, D. F., Hoffman, L. M., Bohman, T., Champlin, C. A., Thibodeau, L.,
Widen, J., Brandel, J., Friel-Patti, S. F. (2008). The efficacy of Fast ForWord Language
Intervention in school-age children with language impairment, A randomized controlled
trial. Journal of Speech, Language, and Hearing Research, 51, 97-119.
• Schooling, T., Venediktov, R., Leech, H., EB Evidence-Based Systematic Review:
Effects of Service Delivery on the Speech and Language Skills of Children From Birth to 5
Years of Age ASHA October 2010
• Loeb, D. F., Gillam, R. B., Hoffman, L., Brandel, J., Maruis, J. (2009). The effects of fast
forword language on the phonemic awareness and reading skills of school-age children
with language impairments and poor reading skills. American Journal of Speech-
Language Pathology, 18, 376-387.

54. • Peters-Johnson, C. (1996). Action: School Services. Language, Speech, and
Hearing Services in Schools, 27, 185-187.
• Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, S., & O’Brien, M.
(1997). Prevalence of specific language impairment in kindergarten children.
Journal of Speech, Language, and Hearing Research, 40, 1245-1260.
• Schooling, T., Venediktov, R., Leech, H.,(2910) EB Evidence-Based Systematic
Review: Effects of Service Delivery on the Speech and Language Skills of Children
From Birth to 5 Years of Age ASHA October 2010
• Stahl, S.A. & Fairbanks, M.M. (1986). The effects of vocabulary instruction: A
model-based meta-analysis. Review of Educational Research, 56(1), 72-
110.Ukrainetz et. al. 2009
• Ukrainetz, T., Proctor-Williams, K., Baumann, J., Allen, M., Hoffman, L.,
Justice, L (2008). How Much is Enough? The Intensity Evidence in
Language Intervention. Presentation at the American Speech Language
Association Annual Convention, Chicago
• Pui Fong, Kan(2010). Vocabulary Development and Function in Bilinguals:
Comparison Across the Life span. Presentation at the American Speech
Language Association Annual Convention, Philadelphia

55. Click to visit www.bilinguistics.com

56. Difference or Disorder?
Understanding Speech and Language
Patterns in Culturally and Linguistically
Diverse Students
Rapidly identify speech‐language
patterns related to second language
acquisition to
distinguish difference from disorder.